Frontline Psych with Doc Bender: Treatment Options for PTSD

By Dr. James Bender, DCoE psychologist

Dr. James Bender is a former Army psychologist who deployed to Iraq as the brigade psychologist for the 1st Cavalry Division 4th Brigade Combat Team out of Fort Hood, Texas. During his deployment, he traveled through Southern Iraq, from Basra to Baghdad. He writes a monthly post for the DCoE Blog on psychological health concerns related to deployment and being in the military.

Posttraumatic Stress Disorder, or PTSD, can occur after someone experiences or sees a traumatic event. However, treatments for PTSD exist and work for most people. The sooner you receive treatment, the sooner you can learn skills to manage PTSD symptoms — many of which significantly worsen a person’s quality of life and ability to function over time.

The two main types of treatments available for PTSD include psychotherapy (e.g., prolonged exposure therapy or cognitive processing therapy) and medication (e.g., selective serotonin reuptake inhibitors).

Prolonged Exposure Therapy

 This treatment focuses on the body’s physical stress reaction (racing heartbeat, sweating, nervous feelings, etc.) along with ways to control this reaction. You and your therapist will identify situations where you feel these reactions inappropriately such as in crowded shopping malls or at the rifle range. You’ll then expose yourself to these stressful environments armed with skills that help you relax and manage distress. With time and practice, stress-related reactions will diminish, and you’ll be able to function better in everyday life. There are two reasons why this works. First, you learn how to consciously control your reactions to stressful memories, a skill that comes in handy in many situations. Second, as you become more exposed to stressful conditions, your body will naturally start to change its reaction.

Cognitive Processing Therapy

 You’ll examine thoughts and feelings related to the traumatic event and how it changed your thinking. For example, many people with combat experience may start to think that the world in general is a bad place. This thought will understandably lead to negative moods and attitudes toward the world, yourself and others. The goal is to replace this faulty thought with another, more realistic thought, like “certain parts of the world and certain people are bad, but there are a lot of good places and good people in the world. Right now, I’m in a good place.” This works because there’s a very strong connection between your thoughts and moods. When you identify and challenge thoughts and feelings associated with poor moods, the moods will usually change.

Selective Serotonin Reuptake Inhibitors

 These are in a class of medications initially used to treat depression but two medications in this class are approved by the Food and Drug Administration for PTSD (Paxil and Zoloft). These medications work by allowing your brain to use a certain neurotransmitter called serotonin more effectively. Serotonin has been linked to anxiety, which is a core symptom of PTSD.

So, which treatment is best? That really depends. Some people respond very well to one treatment and not well to others. Some people use a combination of medication and psychotherapy. Medications usually have to be taken for a year or longer while therapy usually lasts eight to 12 sessions with one session per week. The main points to remember are that treatment works and you have options.

For more on PTSD treatment and how it can help you or someone you know, view resources below. Thanks for reading, and stay safe.